Advance directives and personal identity


Published: Dec 22, 2018
Keywords:
advance directives personal identity J.S. Mill Harry Frankfurt Derek Parfit David Velleman Ronald Dworkin Kantian transcendental identity
Γεώργιος Μπούτλας (George Boutlas)
Στέλιος Βιρβιδάκης (Stelios Virvidakis)
Abstract

Advance directives (ADs) are directives that a competent person gives in advance, for her treatment in case she is characterized (legally or by medical evaluation) incompetent for rational decision making that can guide action. ADs may be demands for active or passive euthanasia, raising legal and moral issues concerning their acceptance.
In bioethics, although the view supporting the decisive authority of ADs, without any presuppositions, as expressions of self determination and of “critical interests”, remains dominant, there are strong philosophical objections to their unconditional acceptance. There are two opposed views on this issue: a) The so called extension view that supports the moral authority of ADs. b) The moral authority objection view that questions the moral acceptance of ADs, focusing on the continuity of personal identity (PI) and on the existence of experiential interests. In this paper we attempt to criticize the dominant bioethical view about the moral justification of ADs based on the extension view, dwelling mainly on cases of “happy demented” patients, who have strong experiential interests that can conflict with the “extended” critical interests.
We thus examine first the more influential PI theories in bioethical discourse. These are the biological, the anthropological, the narrative and the psychological theories. Both psychological and narrative conceptions of PI adopt experiential data that are subject to relativistic evaluations and can lead to limitations of, and exceptions from, the concept of personhood. They both demand a thick first person identification of PI, which is then established as personal identity, supposedly grounding the authority of ADs. Despite their dominant position in bioethics, insofar as they lend support to the extension view, they face several objections.
We try to defend the moral authority objection regarding ADs, by adopting a Kantian transcendental account of PI, which provides a rigid kernel that grounds a conception of human dignity as independent from any experiential assessment of abilities. This conception of human dignity also includes patients incompetent to express their will, and is endangered by the unconditional acceptance of ADs. We also investigate a possible moral justification of ADs in Kantian ethics which appeals to Kant’s positions on suicide.

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References
Allison EH. Kant’s Transcendental Idealism. An Interpretation and Defense. Yale Univer-sity Press, New Haven and London, 2004.
Beauchamp T, Childress J. Principles of Bi-omedical Ethics, 6th ed. Oxford University Press, Oxford, 2009.
Churchill LR. Trust, Autonomy, and Ad-vance Directives. Journal of Religion and Health 1989, 28: 175-182.
Davis J. Precedent Autonomy, Advance Di-rectives, and End-of-Life Care. In Steinbock B (ed) The Oxford Handbook of Bioethics: Oxford University Press, New York, 2007: 349-374.
Dresser R, Robertson J. Quality of Life and Non-Treatment Decisions for Incompetent Patients A Critique of the Orthodox Ap-proach. Law, Medicine& Health Care 1989, 17:234-244.
Dworkin R. Η Επικράτεια της ζωής. Απόδοση-εισαγωγή Βασιλόγιαννης Φ. Εκδόσεις Αρσενίδης, Αθήνα.
Firlik AD. Margo's Logo. JAMA 1991, 265: 201.
Frankfurt H. Freedom of the Will and the Concept of a Person. The Journal of Philoso-phy 1971, 68: 5-20.
Ηill, TE, Jr. Self-Regarding Suicide: A Mod-ified Kantian View. In: Autonomy and Self-Respect. Cambridge University Press, Cam-bridge and New York, 1991.
Kant I. Κριτική του καθαρού Λόγου. Εισαγωγή- μετάφραση-σχόλια Γιανναράς Α. Παπαζήσης, Αθήνα, 1979.
Kant I. Τα θεμέλια της μεταφυσικής των ηθών. Μετάφραση Τζαβάρας Γ. Δωδώνη, Αθήνα –Γιάννινα, 1984.
Kant I. Lectures on Ethics. Translation Heath P. Heath P, Schneewind JB (ed). Cambridge University Press, Cambridge and New York, 1997.
Kant I. Κριτική του καθαρού Λόγου, υπερ-βατική διαλεκτική- υπερβατική μεθοδολογία. Μετάφραση Δημητρακόπουλος Μ. Αθήνα, 2006.
Kant I. Μεταφυσική των ηθών. Μετάφραση, σημειώσεις, επιλεγόμενα, Ανδρουλιδάκης Κ. Eκδόσεις Σμίλη, Αθήνα, 2013.
Kitcher P. Kant’s Transcendental Psychology. Oxford University Press, New York Oxford, 1990.
Locke J. Δοκίμιο για την ανθρώπινη νόηση. Εισαγωγή- μετάφραση-σχόλια Ξανθόπουλος Χ. Εκδόσεις Παπαζήση, Αθήνα, 2016.
Louden R. Kant's Impure Ethics, From Ra-tional Beings to Human Beings. Oxford Uni-versity Press, USA, 2002.
Masferrer A, García-Sánchez E. Vulnerabil-ity and Human Dignity in the Age of Rights. In Masferrer A, García-Sánchez E (ed) Hu-man Dignity of the Vulnerable in the Age of Rights. Springer International Publishing, Switzerland, 2016:1-28.
O’Neill O. Paternalism and Partial Autonοmy. Journal of medical Ethics 1984, 10:173-178.
Parfit D. Reasons and Persons. Oxford Uni-versity Press, Oxford, 1984.
Robertson JA. Second Thoughts on Living Wills. The Hastings Center Report 1991, 21: 6-9.
Rosen M. Dignity, Its History and Meaning. Harvard University Press, Cambridge, Mas-sachusetts, and London, England, 2012.
Schechtman M. Staying Alive, Personal Identity, Practical Concerns, and the Unity of a Life. Oxford University Press, Oxford, 2014.
Shoemaker D. Personal Identity and Ethics. Zalta EN (ed) The Stanford Encyclopedia of Philosophy, 2016.
Tsinorema S. The Principle of Autonomy and the Ethics of Advance Directives. Syn-thesis Philosophica 2015, 59: 73-88.
Velleman D. A Right of Self Termination? Ethics 1999, 109: 606 - 628. Velleman, D. Identification and Identity. In Self to Self Selected Essays. Cambridge University Press, New York, 2007.
Wood A. Kant on Duties Regarding Nonrational Nature. Aristotelian Society Supplementary Volume 1998, 72: 189-210.
Βασιλόγιαννης Φ. Ευθανασία και εγγενής αξία της ανθρώπινης ζωής. Ομιλία στη δη-μόσια εκδήλωση του Κέντρου Φιλελεύθερων Μελετών «Μάρκος Δραγούμης», την 4.10.2016 στην Αθήνα, με θέμα: Ευθανασία: δικαίωμα ή έγκλημα;.
ΕΕΒ (Εθνική Επιτροπή Βιοηθικής). Σύσταση: Η δεσμευτικότητα των οδηγιών μη ανάνηψης). Εθνικό Τυπογραφείο, Αθήνα, 2013.
Καντιάνης Α. Δικαίωμα στον προσωπικό θάνατο: το παράδειγμα του Αρχιεπισκόπου. Εφημερίδα Καθημερινή, 26.1.2008.
Παπαδάκη Λ. Ζητήματα ηθικής φιλοσοφίας και βιοηθικής. Καντιανές προσεγγίσεις. Νήσος, Αθήνα, 2017.
Πεντζοπούλου-Βαλαλά Τ. Σέξτος ο Εμπειρικός. Ζήτρος, Αθήνα, 2007.
Πρωτοπαδάκης Ε. Η Ευθανασία και το δια-κύβευμα της αυτονομίας. Στο Κανελλοπούλου-Μπότη Μ, Παναγοπούλου-Κουτνατζή Φ (επιμ.) Βιοηθικοί Προβληματισμοί ΙΙ, Το πρόσωπο. Εκδόσεις Παπαζήση, Αθήνα, 2016:115- 135.
Ρεθυμιωτάκη, Ελένη. Ευθανασία και διαθήκες ζωής. Στο Δρακοπούλου Μ (επιμ) Ευθανασία. Αφιέρωμα στον πρώτο πρόεδρο της Επιτροπής Γεώργιο Κουμάντο. Εθνική Επιτροπή Βιοηθικής 10 Χρόνια Λειτουργίας 1999-2009. Εκδόσεις Σάκκουλα, Αθήνα, 2012: 153-194